You Are Not Broken

Episode 394 – Dr. Susan MacDonald on Testicular Pain, Pelvic Floor Dysfunction, and Rebuilding Life After Stage 4 Breast CancerNormal scan. Normal labs. Still in pain. Now what?Dr. Casperson is joined by fellow urologist Dr. Susan MacDonald for a conversation that starts with male pelvic pain and ends somewhere much more personal. They discuss why men with testicular pain are so often dismissed, how chronic pain gets mislabeled, and why pelvic floor dysfunction and referred pain get missed again and again.Then Dr. MacDonald shares her own story. She was diagnosed with de novo stage 4 bilateral breast cancer after missing her own early symptoms, and she describes what it's like to go from surgeon to patient. She talks openly about fatigue, grief, hormonal changes, and the career pivot she never chose. She also explains why she now wants to help patients move beyond survival mode toward resilience and joy.In this episode:How Dr. MacDonald found urology by accident (Grand Rounds, free pizza, and the realization that it's a surgical specialty)Why male reconstruction and urethroplasty won her overWhat urethral strictures are, and why tissue from inside the cheek is used to repair themHow common testicular and pelvic pain is. She estimates about 5% of urology consults.Why chronic pain is harder to treat than a kidney stone, and why normal imaging doesn't mean the pain isn't realThe harm of forcing a diagnosis, and patients carrying "heavy bricks in a backpack" of labelsThinking through a differential diagnosis out loud, with the patient as a partnerPlacebo effects, and why antibiotics can seem to help even when infection isn't the causePelvic floor dysfunction as the missing center of the Venn diagram, and the value of working with pelvic floor physical therapistsHer stage 4 breast cancer diagnosis, and how surgeons are trained to ignore their own bodiesLiving through treatment: fatigue, insomnia, arthritis, hormonal changes, and griefWhy leaving full-time academic surgery was forced, not voluntary, and her pivot into video education and speakingSex after cancer, and why the messaging for men and women is so differentTart cherry juice and hot flashesDr. MacDonald Linked InAs always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Clinic is OpenListen to this podcast on Pinnacle to earn CMEThanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Dr. Casperson is joined by Dr. Rebbecca Hertel, DO, MSCP, for a candid conversation about getting stronger through perimenopause and beyond. They talk about how hormonal shifts change training, recovery, and body composition. They also cover why bone health deserves your attention now, and how to read research and lab results with a critical eye.Along the way, Dr. Hertel explains what osteopathic medicine actually is. She also shares why your pain might not be coming from where you feel it. The two dig into protein, GLP-1s, testosterone, and hormone therapy, and why finding a clinician who listens matters as much as any prescription.In this episode:What osteopathic medicine and osteopathic manipulative treatment (OMT) involveWhy pain can show up somewhere other than its sourceHow perimenopause affects muscle, recovery, sleep, and body compositionWhy gaining muscle in midlife takes longer, and why it's still worth itBone health, fracture prevention, and the case for resistance trainingProtein, hydration, and fueling your body during weight lossGLP-1 medications and strategies to help preserve muscleHormone approaches in perimenopause and postmenopauseWhy hormone therapy is not contraceptionTestosterone: symptoms, side effects, and how to think about lab resultsHealth span, independence, and prevention across the lifespanHormone stigma and the need for better education at puberty, postpartum, and midlifeDr. Hertel's IGDr Hertel's WebsiteAs always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Clinic is OpenListen to this podcast on Pinnacle to earn CMEThanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Episode 392 – When in Menopause: Advocacy, Policy, and the Power of Speaking UpWho gets to be a menopause advocate? You do. You probably already are.Dr. Casperson sits down with Jennifer Weiss-Wolf, a lawyer, women's leadership leader at NYU Law, and author of When in Menopause: A User's Manual and Citizen's Guide. Jennifer helped drive the fast, bipartisan wins in period policy. Now she's applying those lessons to menopause, and she's honest about why this one is harder.They cover where the policy wins are coming from, what still blocks progress, and why workplace perks miss the point. They also talk about why the real work is bigger than any one issue. If you're a clinician, an advocate, or just someone who wants to make change without a big platform, this one is for you.In this episode:How Jennifer moved from menstruation policy to menopause around 2020. It started with a friend's question about the policy landscape, not with her own symptoms.Advocacy as a choose-your-own-adventure. Legislative language, storytelling, and community-building all count.What period policy taught her about state-level wins and working across the aisle.Why menopause reform is more complicated than it looks. Decades of neglected science and deeply interconnected issues make it hard. She describes the field as organic rather than fractured.Language, stigma, and culture. How do you change policy when people still can't say "vagina" in public or on social media?Why most workplace accommodations fall short. Many are too small, too generic, or built on a weak understanding of menopause. Protections also have to come before anyone asks employees to disclose.The legal gap. The U.S. has no clear anti-discrimination protection for menopause. The ADA, pregnancy protections, and age-discrimination law help in some cases, but they leave holes.What actually moves the needle: access, research funding, clinician education and training, and reimbursement reform. Business leaders should fund these upstream fixes instead of offering superficial perks.Clinicians already have a platform. Patient visits, office materials, and staff handouts all spread accurate information, and small repeated messages add up.Community is the engine. Jennifer's examples include gyms, book clubs, schools, libraries, and PTAs. Midlife women are an underestimated political and social force.Jennifer's IGJennifer's New BookAs always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Clinic is OpenListen to this podcast on Pinnacle to earn CMEThanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Dr. Sameena Rahman on menopause, PMDD, PCOS, and why naming things mattersThis week I sat down with practicing gynecologist Dr. Sameena Rahman to talk about some of the most misunderstood areas in women's health: hormone replacement after oophorectomy, PMDD, and the recent renaming of PCOS. We move fast from clinical nuance to culture, stigma, and medical bias, and you'll walk away with plenty of practical takeaways whether you're a patient or a clinician.Sameena also shares the story behind her book, Brown Girls Disease, and why she's reclaiming language around pain, shame, and access to care.In this episode, we talk about:Why women who have their ovaries removed need full hormone replacement, not just a low-dose patchThe difference between menopause management and medical neglect after hysterectomy or oophorectomyThe evidence that early menopause plus hormone therapy can have major survival benefitsWhat PMDD is, how it differs from typical PMS, and why it can feel like "Jekyll and Hyde" every monthWhy PMDD may be more about hormone sensitivity and brain receptor interactions than progesterone alonePMDD treatment options, including SSRIs, specific birth control formulations, progesterone, and in extreme cases medical suppressionWhy the old label PCOS creates stigma and hides the cardiometabolic risk behind the syndromeThe new name, polyendocrine metabolic ovarian syndrome, and why I think the rename could finally bring primary care and internal medicine into the conversationHow PCOS affects fertility, diabetes risk, heart health, weight gain, and endometrial cancer riskHow pelvic pain, vaginismus, and sexual dysfunction are shaped by culture, religion, and medical biasWhy Sameena chose the title Brown Girls Disease as a way of reclaiming a term that had been used dismissivelyHow language changes care, from saying "vagina" out loud to replacing shame-based terms with clearer onesNaming things matters. You are not broken.Dr. Rahman's IGAs always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Clinic is OpenListen to this podcast on Pinnacle to earn CMEThanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode, I sit down with Dr. Melissa Mauskar, a vulvar dermatologist at UT Southwestern, for a wide-ranging conversation about vulvar skin conditions, common misdiagnoses, and why so many patients are told to just "wait and see" when they actually need an exam. We dig into GSM, estrogen, OTC yeast treatments, soaps, waxing, and the biggest myths that keep women from getting real care.If you've ever been told itching, burning, or irritation is "normal," this conversation explains why that advice can delay diagnosis for years, and what to do instead.What We CoverWhat vulvar dermatology is, and why the vulva deserves the same care as skin anywhere else on the bodyWhy so many patients see 5 or 6 clinicians before getting the right diagnosis, often because no one ever actually examined the vulvaHow symptoms get mislabeled as yeast when the real culprit is lichen sclerosus, psoriasis, eczema, contact dermatitis, or GSMWhy numbing products like Vagisil (and benzocaine specifically) can become irritants or allergens that make things worseBarrier care for "red angry vulva," including zinc oxide for irritation and moisture-related skin breakdownHow overcleaning, douching, and scented washes disrupt the vulvar microbiome — and the shame baked into that marketingWaxing, microtrauma, and hair as a protective barrierGSM, recurrent UTIs, and why vaginal estrogen is still so underprescribedLate diagnosis of vulvar melanoma, and why genital skin needs to be looked at, not just talked about over telehealthNotable Quotes"My five year old can say vulva.""I really like talking about uncomfortable things and making comfortable people uncomfortable.""Just do what brings you joy."About Dr. Melissa MauskarDr. Melissa Mauskar is an Associate Professor of Dermatology and of Obstetrics and Gynecology at UT Southwestern Medical Center, where she's the founder and Director of the Vulvar Health Program — a tertiary referral center for gynecologists, dermatologists, and primary care physicians across Texas and the nation. She's a Fellow of the International Society for the Study of Vulvovaginal Diseases (ISSVD), founding president of the Vulvar Dermatoses Research Consortium, and serves on the board of the Women's Dermatologic Society. Learn more at utswmed.org/doctors/melissa-mauskar.As always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.